Most of you will know that there is a lot of research showing links between healthy behaviors (such as exercise, healthy diet, and not smoking) and better health in people with multiple sclerosis (MS), as with people without MS.

Improving lifestyles leading to better health outcomes?

What researchers are currently trying to find out is whether people with MS who improve their lifestyles have better health outcomes. Health outcomes may be measured in the number of relapses, a measure of disability, or quality of life.

Our study, which was just published in PLoS One, tried to answer a small piece of this puzzle. The Overcoming MS (OMS) lifestyle retreats, that have run for many years in Victoria, Australia, promote healthy lifestyle behaviors, in a group setting over five days.

People attending a retreat receive information and interactive sessions on why and how to eat healthily, exercise, manage stress using meditation, and other factors that may help them manage their MS, such as vitamin D and omega-3 supplementation.

The study

In this study we asked people to complete questionnaires about their health behaviors and their health outcomes (mental and physical quality of life, relapses and disability) before they entered the retreat, and one and three years after.

We wanted to know: 1) if people had taken up or maintained healthy behaviors; and 2) if their health outcomes had changed over time.

Ninety-five people (69 women and 26 men) agreed to be part of this study and completed the questionnaires before they started the retreat (at baseline).

They were on average 44 years old, half had MS for less than 2 years when they completed the baseline questionnaire and 72% had relapsing remitting MS.

After one and three years; 76 and 78 respectively completed the follow-up questionnaires again. 57% used MS medication at baseline, and this went up to 72% at the one year and 69% at the three year follow-up. In terms of healthy behaviors, our results showed that these people had a slightly healthier diet score (from 86/100 to 91/100 one year later and 89/100 three years later).

Where 65% were practising meditation for one hour or more per week at baseline, this went up to 89% at one year and then to 78% at three years. Many supplemented with vitamin D, 47% at baseline and then 73% at one year and 69% at three year follow-up. Similarly, supplementing with flaxseed oil (plant-based source of omega-3 fatty acids) went up from 37% at base

line to 82% at one year and 76% at three years. We did not see a change in the proportion of people doing exercise and we did not have enough smokers in the study for analyses. In terms of health outcomes, our results showed that people reported approximately 8-9/100 points better mental and physical quality of life at one and three year follow-up compared to baseline. They also reported fewer relapses than at baseline. 

No change in disability

There was no change in disability. This is of course good news for the people that were included in this study, as their overall health seems to have improved and their disability did not get worse over the three year period of the study.

It was also interesting to see that while most increased their healthy behaviors after the retreat, this slightly decreased after three years, but remained better than baseline. However, we saw no change in exercise, and the change in diet was relatively small.

There are a few things to keep in mind when interpreting these results. First, most people in this study were already very healthy and highly motivated to stay healthy, and most had a university degree and were employed. Therefore, participants in our study may not reflect the average person with MS.

Second, we did not compare to a control group of people with MS who did not participate in the retreats. So we cannot be sure that the people in our study would have had different health outcomes if they had not gone to a OMS retreat, especially because medication use also increased.

Finally, as is often the case when using questionnaires, it is possible that people don’t correctly remember their behavior in the past (for example, they may overestimate how much time they spent in the gym last week). Future research could overcome some of these problem by including more objective measures of health behaviors, a control group to be able to compare health outcomes between groups, and a more representative sample of people with MS.

In conclusion

To conclude, people who choose to take part in one of the OMS retreats overall reported an increase in vitamin D and omega-3 supplementation, meditation practice and MS medication use. There were small improvements in diet score, but no change in exercise.

Three years after the retreat, these lifestyle behaviors had decreased slightly, but remained better than at baseline. Participants reported better mental and physical quality of life and fewer relapses than at baseline. To confirm that there is a causal relationship, e.g. that health behaviors cause better health outcomes, more research is needed, so stay tuned!

Dr Claudia Marck, Lead Researcher

More on these results: Three-year STOP-MS study results

Full paper: Marck CH, De Livera AM, Brown CR, Neate SL, Taylor KL, Weiland TJ, et al. (2018) Health outcomes and adherence to a healthy lifestyle after a multimodal intervention in people with multiple sclerosis: Three year follow-up. PLoS ONE 13(5): e0197759.

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